Extension Block Pinning versus percutaneous Fragment Reduction with a Towel Clip and extension Block Pinning with direct Pin Fixation for Treatment of Mallet Fracture

Abstract

Purpose This study compared the clinical and radiographic results between extension block pinning (Group A) and percutaneous reduction of the dorsal fragment with a towel clip followed by extension block pinning with direct pin fixation (Group B) for the treatment of mallet fractures.

Patients and Methods A total of 69 patients (group A = 34 patients, group B = 35 patients) who underwent operative treatment for mallet fractures from June 2008 to November 2017 with ≥ 6 months post-surgical follow-up were analysed retrospectively. The extent of subluxation of the distal interphalangeal joint, articular involvement of fracture fragment, fracture gap, and articular step-off were examined on plain radiographs before and after surgery. The functional outcomes were evaluated with the Crawford rating system.

Results The postoperative step-offs were 0.16 mm in group A and 0.01 mm in group B. Group B had a significantly better anatomical outcome than group A. Five patients in group A had a loss of reduction. Among them, two had malunion and post-traumatic arthritis. Meanwhile, no patients in group B presented with loss of reduction and nonunion. The mean extension lags were 4.2° in group A and 1.6° in group B. However, functional outcome did not differ between the two groups at the final follow-up.

Conclusion Fracture reduction using a towel clip and extension block pinning with direct pin insertion for mallet fracture facilitated the anatomical reduction of fragments, and allowed for stable fixation of fragments. Compared with extension block pinning technique, this technique has shown better anatomical results and stability, but not better clinical results.

Zusammenfassung

Ziel Vergleich der klinischen und radiologischen Ergebnisse knöcherner Strecksehnenausrisse nach Extension-block-pinning (Gruppe A) versus Reposition mit einer Tuchklemme, Extension-block-pinning und direkter Drahtfixation des Fragmentes (Gruppe B).

Patienten und Methoden Die klinischen und radiologischen Ergebnisse von 69 Patienten (Gruppe A = 34, Gruppe B = 35 Patienten), bei denen zwischen Juni 2008 und November 2017 ein knöcherner Strecksehnenausriss am Fingerendglied operativ versorgt wurde mit einer Nachbeobachtungszeit von ≥ 6 Monaten, wurden retrospektiv ausgewertet. Erfasst wurde das Ausmaß der Subluxation des Endgliedes, die Größe des Knochenfragmentes und des Frakturspaltes sowie die Gelenkstufe prä- und postoperativ. Das klinische Ergebnis wurde mittels der Crawford-Klassifikation beurteilt.

Ergebnisse Postoperativ betrug die verbliebene Gelenkstufe in Gruppe A 0,16 mm, in Gruppe B 0,01 mm. Patienten der Gruppe B hatten insgesamt bessere radiologische Ergebnisse. Bei 5 Patienten der Gruppe A kam es zu einem Repositionsverlust; 2 davon entwickelten eine Arthrose. Im Gegensatz dazu kam es bei keinem Patienten der Gruppe B zu einem Repositionsverlust oder einer Pseudarthrose. Das Streckdefizit in Gruppe A betrug durchschnittlich 4,2°, in Gruppe B 1,6°. Allerdings fanden sich bei der letzten Nachuntersuchung keine Unterschiede bzgl. des klinischen Ergebnisses.

Schlussfolgerung Die geschlossene Reposition eines knöchernen Strecksehnenausrisses am Fingerendglied mit nachfolgendem Extension-block-pinning und direkter Drahtfixation des knöchernen Fragmentes resultiert in einer anatomiegerechten Wiederherstellung des Gelenkes und einer sicheren Fixation des Fragmentes. Im Vergleich mit dem alleinigen Extension-block-pinning sind die radiologischen, jedoch nicht die klinischen Ergebnisse besser.

Key words

Knöcherner Strecksehnenausriss - Extension-block-pinning

Schlüsselwörter

Mallet finger - extension block pinning

Publication History

Received: 13 January 2021

Accepted: 15 July 2021

Article published online:
28 September 2021

• References

• 1 Wehbe MA, Schneider LH. Mallet fractures. J Bone Joint Surg Am 1984; 66: 658-669
• 2 Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am 2018; 43: 146-163e
• 3 Yoon JO, Baek H, Kim JK. The Outcomes of Extension Block Pinning and Nonsurgical Management for Mallet Fracture. J Hand Surg Am 2017; 42: 387.e1-387.e7
• 4 Damron TA, Engber WD. Surgical treatment of mallet finger fractures by tension band technique. Clin Orthop Rel Res 1994; 300: 133-140
• 5 Bloom JM, Khouri JS, Hammert WC. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg 2013; 132: 560e-566e
• 6 Hofmeister EP, Mazurek MT, Shin AY. et al. Extension block pinning for large mallet fractures. J Hand Surg Am 2003; 28: 453-459
• 7 Auchincloss JM. Mallet-finger injuries: a prospective, controlled trial of internal and external splintage. Hand 1982; 14: 168-173
• 8 Bischoff R, Buechler U, De Roche R. et al. Clinical results of tension band fixation of avulsion fractures of the hand. J Hand Surg Am 1994; 19: 1019-1026
• 9 Jupiter JB, Sheppard JE. Tension wire fixation of avulsion fractures in the hand. Clin Orthop Rel Res 1987; 214: 113-120
• 10 Ishiguro T, Itoh Y, Yabe Y. et al. Extension block with Kirschner wire for fracture dislocation of the distal interphalangeal joint. Tech Hand Up Extr Surg 1997; 1: 95-102
• 11 Darder-Prats A, Fernandez-Garcia E, Fernandez-Gabarda R. et al. Treatment of mallet finger fractures by the extension-block K-wire technique. J Hand Surg Br 1998; 23: 802-805
• 12 Yamanaka K, Sasaki T. Treatment of mallet fractures using compression fixation pins. J Hand Surg Br 1999; 24: 358-360
• 13 Kronlage SC, Faust D. Open reduction and screw fixation of mallet fractures. J Hand Surg Br 2004; 29: 135-138
• 14 Ishiguro T. A new method of closed reduction for mallet fractures. J Jpn Soc Surg Hand 1988; 5: 444-447
• 15 Tetik C, Gudemez E. Modification of the extension block Kirschner wire technique for mallet fractures. Clin Orthop Rel Res 2002; 404: 284-290
• 16 Tsubokawa N. Modified Ishiguro’s Method for Large Mallet Fractures. J Jpn Soc Surg Hand 2005; 22: 58
• 17 Han K, Moon J, Chung N. et al. Treatment of mallet fracture of the fingers by percutaneous reduction and pinning. J Korean Soc Surg Hand 2003; 8: 153-157
• 18 Patel MR, Desai SS, Bassini-Lipson L. Conservative management of chronic mallet finger. J Hand Surg Am 1986; 11: 570-573
• 19 London PS. Molded polythene splint for mallet finger deformities. J Hand Surg Am 1985; 10: 157-158
• 20 Alla SR, Deal ND, Dempsey IJ. Current concepts: mallet finger. Hand 2014; 9: 138-144
• 21 Kim JK, Kim DJ. The risk factors associated with subluxation of the distal interphalangeal joint in mallet fracture. J Hand Surg Eur Vol 2015; 40: 63-67
• 22 Giddins GE. Bony mallet finger injuries: assessment of stability with extension stress testing. J Hand Surg Eur Vol 2016; 41: 696-700
• 23 Inoue G. Closed reduction of mallet fractures using extension-block Kirschner wire. J Orthop Trauma 1992; 6: 413-415
• 24 Schneider LH, Wehbe MA. Operative treatment of intra-articular fractures of the dorsal aspect of the distal phalanx of digits. J Bone Joint Surg Am 1988; 70: 150-151
• 25 Akgun U, Bulut T, Zengin EC. et al. Extension block technique for mallet fractures: a comparison of one and two dorsal pins. J Hand Surg Eur Vol 2016; 41: 701-706
• 26 Lee YH, Kim JY, Chung MS. et al. Two extension block Kirschner wire technique for mallet finger fractures. J Bone Joint Surg Br 2009; 91: 1478-1481
• 27 Kim JY, Lee SH. Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures. J Hand Surg Am 2016; 41: 414-419
• 28 Hiwatari R, Saito S, Shibayama M. The ‘chased method’ of mini screw fixation: a percutaneous surgical approach to treating mallet fractures. J Hand Surg Eur Vol 2014; 39: 784-786
• 29 Jiang B, Wang PJ, Zhao JJ. The treatment of bony mallet fingers using a triple K-wire fixation technique. J Hand Surg Eur Vol 2015; 278 (40) 864-866
• 30 Usami S, Kawahara S, Kuno H. et al. A retrospective study of closed extension block pinning for mallet fractures: Analysis of predictors of postoperative range of motion. J Plastic Reconstr Aesthet Surg 2018; 71: 876-882